Question

How does long-term trauma affect a child’s development?

The Research

In 2000, Annette Streeck-Fischer and Bessel van der Kolk authored a brilliant review of the research on chronic trauma and child development. They integrated object relations, attachment and cognitive development theory with biology and neuroscience to create a comprehensive and powerful picture of the multiple layers of impact that long-term (as opposed to single incident) trauma has on the development and behavioral trajectories of children and youth. The article argues convincingly that such long-term traumatic exposure frequently interferes with a child’s ability to:

• play (critical to developing self-control and competence)
• develop object constancy (central to perceiving interpersonal messages accurately)
• establish attachments (with a simultaneous impact on self-regulation)
• solve life problems (e.g., generating fight/flight responses or impulsivity)
• stay in reality (i.e., dissociation, disintegration)

Referencing more recent research in biology and neuroscience, the authors discuss the impact of such trauma on the “hypothalamic-pituitary-adrenal axis” and various parts of the brain. They then explain how this impact reduces a child’s ability to experience life events accurately, reflect upon them, or make important rational, logical or causal connections. The authors then offer a wide variety of ways this long-term trauma may present itself in a child or adolescent, including becoming developmentally regressed; self-destructive; impulsive; anti-social; substance abusing; and suffering from major sensory, attention, and learning problems. The authors point out that all of these states serve to eliminate perceived threats and to regulate emotional distress. Based upon these findings, they conclude with a more hopeful message that describes the elements of the healing process. They include a safe environment, opportunities for non-interpersonal play and mastery, and the presence of a consistent and predictable caregiver. There have been many articles on trauma generally; Streek-Fischer and van der Kolk have provided an excellent platform for understanding all subsequent research.

Implications for Professionals

A high percentage of children and adolescents who sexually abuse have experienced long-term trauma. Too often, the diagnostic labels of ADHD, Conduct Disorder, Sensory Disorder, Learning Disabilities, and others mask the long-term trauma that this population has experienced. The result is that professionals may ascribe intentionality as well as attitude and motivational deficits to what may actually be deeply ingrained, unconscious survival strategies. Professionals working with children and adolescents who have experienced long-term trauma must bring to each child a very high level of treatment skill, a deep understanding of all the manifestations of severe trauma as well as abuse-specific interventions. Only then are we able to both manage the sexually abusive behavior and heal the trauma. It is crucial that we honor this complexity and develop the skills to implement the most effective intervention strategies.

Implications for the Field

Twenty plus years ago, the mantra for addressing sexually abusive children and adolescents was “deal with what you have done to others first, then…” Over the years, we have learned the folly of that simplistic approach. This article reinforces the necessity of addressing trauma concomitantly in all its manifestations while establishing safety and managing risk. The perspectives advanced in this article offer an important foundation for the field and lead us to more holistic and integrated treatment approaches that create the opportunity for both healing and more effective self-regulation. The sophistication necessary to implement this approach effectively raises the bar for more comprehensive training and broader supervisory responsibilities. These holistic and integrated interventions will improve a child or adolescent’s chances for a better life and will ultimately prevent future victims and improve community safety.

Abstract

This review examines the clinical outcomes associated with exposure to chronic intrafamilial and [other] trauma and explores the treatment of the psychological, biological and cognitive sequelae. Exposure to intrafamilial violence and other chronic trauma result in pervasive psychological and biological deficits. Treatment needs to address issues of safety, stabilize impulsive aggression against self and others, promote mastery experiences, compensate for specific developmental deficits and judiciously process both the traumatic memories and trauma-related expectations.

Citation

• Streeck-Fischer, A. & van der Kolk, B.A. (2000). Down will come baby, cradle and all: Diagnostic and therapeutic implications of chronic trauma on child development.
  Australian and New Zealand Journal of Psychiatry, 34, 903-918.

Question

Are the developmental risk factors that lead to sexual abusing behaviors similar to risk factors for non-sexual violent behaviors?

The Research 

Researchers appear to fall into two key theories for sexually offending behaviors. Some believe that sexual abuse by adolescents is part of a larger pattern of antisocial thinking and behavior. The “generalist model” suggests that many of the risk factors for continued sexual abuse are the same or similar to those for continued illegal behavior. However, others have emphasized a more “specialist” perspective; suggesting, that adolescents who abuse are fundamentally different from others.

Sharon Wanklyn and her colleagues studied 224 adolescent males in Ontario. They sought to explore the specialist and generalist perspectives by examining childhood antecedents among three subgroups of adolescents:

• Those who have abused exclusively sexually (PSO)
• Those who have engaged in non-sexual violence (VNSO)
• Those who have abused both sexually and violently (VVSO)

The authors noted that these three subgroups share common as well as distinct features. For example, the authors found that those adolescents who had sexually abused were more sexually precocious and more likely to have an adolescent mother than the non-sex offending subgroup. They also found that the teens who abused both sexually and violently were much more likely to have histories of emotional, physical, and sexual victimization but that these characteristics were found to a lesser degree in the other subgroups as well.. Other factors showed no significant difference across the subgroups including:

• Poor school behavior
• Substance use
• Criminal family members
• Parental psychopathology
• Peer relations
• Family disruption or transitions

Given their findings, the authors concluded that there is empirical support for both the generalist and specialist perspectives of sexual abuse by adolescents.

Implications for Professionals

This study investigated risk factors in adolescents with the understanding that the impact of exposure will vary depending upon when a child or teen is exposed to these risk factors in their lives. The impact can make a significant difference in a child or adolescent’s life trajectory. Thus, this study points to the importance of understanding developmental factors for each youth, and the contexts in which they have grown up. Where programs once treated sexual abuse as a singular phenomenon, these findings contribute to the consensus that many factors contribute to sexual abuse, when these factors occur in a child’s development is significant in how it impacts that child or adolescent, and that adolescents who abuse are a diverse group. The study adds to the current consensus that adolescents who sexually abuse are in most ways, like other adolescents who are delinquent. The research also opens the door into a critical debate around what is the meaning of “specialized” assessment or treatment. While addressing this important conversation in only peripheral ways, this research reminds us that it is essential for professionals to formulate cases with a deep understanding of both traditional clinical/developmental understanding as well as the elements that may be unique to sexual behaviors. Therefore, assessment and treatment should take into account each of the risk factors discussed as well as the developmental impact of these factors in each individual.

Implications for the Field

In the upcoming years, the challenge to our field is how to develop an integrated and holistic approach to working with adolescents who sexually abuse which incorporate all aspects of treatment that are unique to this population. If the field started with a gross overweighting of adult concepts, we now risk abandoning all aspects of difference as the pendulum swings back (as well it should). More research and best practice thinking will be required to reach consensus on this very critical issue of specialization vs. generalization. However, as we proceed, it is vital to remember that youth are more influenced by their environment than adults, and require a greater level of guidance. Therefore the findings indicate that there is a large opportunity for prevention programs that find ways to utilize this information when working with adolescents. These findings show that while teaching sexual health and respect is vital to prevention, it is essential that these curricula also address past traumatic and other adverse experiences. Finally, these findings offer a sense of hope to all of us when applied to strategies for preventing sexual abuse by adolescents in the first place.

Abstract

Understanding the developmental precursors of juvenile violent sex offending can contribute to the promotion of effective early intervention and prevention programs for high-risk children and youth. However, there is currently a lack of research on the early characteristics of adolescents who commit violent sex offenses. Drawing on the literature regarding the generalist and specialist positions of criminal behavior, the aim of the present study was to compare childhood risk factors for three groups of juvenile offenders: (a) pure sex offenders (PSO; n = 28); (b) violent non-sex offenders (VNSO; n = 172); and (c) versatile violent sex offenders (VVSO; n = 24). Nineteen risk factors comprising four life domains
(individual, family, peer, and school) were identified from a file review. Three hierarchical logistic regression analyses examined associations between risk factors and offender groups. The results reflected the underlying heterogeneity of the sample, offering support for both the specialist and generalist positions of criminal behavior. PSOs differed from VNSOs on the basis of higher odds for precocious sexual behavior. Second, VVSOs differed from VNSOs on the basis of higher odds for precocious sexual behavior, criminal family members, and an adolescent mother, as well as lower odds for poor school behavior. Third, PSOs were marginally more likely to have engaged in early overt antisocial behavior compared with VVSOs. Fourth, many of the childhood risk factors examined were not associated with any offender group. In conclusion, VVSOs appeared to differ on the greatest number of risk factors from VNSOs, suggesting that VVSOs share a more similar developmental pathway with PSOs. The prevention and future research implications of these findings are discussed.

Citation  

Wanklyn, S.G., Ward, A.K., Cormier, N.S., Day, D.M., & Nelson, J.E. (2012). Can we distinguish juvenile violent sex offenders, violent non-sex offenders, and versatile violent sex offenders based on childhood risk factors? Journal of Interpersonal Violence. Published online before print. DOI: 10.1177/0886260511432153.

by

Question

What do we know about adolescents who sexually abuse in a group or a gang?

The Research
‘t Jart-Kerkhoffs, Vermeiren, Jansen, and Doreleijers conducted a study on 89 adolescents in the Netherlands who had participated in group rapes. Typically, the committed offenses were of high severity and consisted of rape, often accompanied by excessive violence. The researchers indicate that between 11% and 80% of juvenile offenses in the Netherlands are committed in groups. This study examined the differences in intelligence and offense-related psychosocial characteristics of juvenile group sex offenders. Contrary to the researchers’ expectations, their study revealed little difference between leaders and followers with the exception of leaders having more emotional problems (an unexpected result), followers using more force, and followers having more social impairments than leaders. The social impairments found in the followers supports previous research that through loyalty or intimidation, the intentions of the leader become the actions of the entire group. The researchers hypothesized the lack of greater difference might have been due to: 1) the small number of leaders being studied, and 2) changing roles within the group during the offenses (e.g., leaders initiating or encouraging the group to act, but followers taking on leadership roles once the offense had been initiated).  As with many other studies, this research found extremely low levels of sexual recidivism, but high levels of general delinquency. Further, the study did reveal high levels of trauma experience in both leaders and followers, up to 80% experiencing at least one traumatic life event (a recurring risk factor in a number of risk assessment studies with juveniles).

Implications for Professionals

This is one of the only studies of adolescent group sexual behavior although a few have been conducted for adults. As the authors themselves indicate, more research is needed to identify differentiating factors, if any, amongst those who are leaders, those who are willing followers and those who are reluctant followers.  The heinous nature of many group rape offenses often prompts a common view of all group participants. From this study, the question of difference remains open, but anecdotal clinical observation suggests there may be significant differences amongst group members requiring different case formulations, treatment plans, and risk management strategies. As is becoming increasingly apparent, professionals must conduct very careful developmentally sensitive risk assessments to truly understand sex offending behaviors. This may be even more critical in group offending situations in order to avoid seeing all participants as identical.

Implications for the Field

Given the severity and violence associated with most group sex offenses, there is a compelling need for greater understanding of:

• The role of emotional problems in group offenders,
• The difference if any amongst group members,
• The types of prevention strategies that can mitigate against delinquent group bonding, and
• The skills required to weaken peer-influenced sexual behaviors.

Further, given the unanimity of studies both in the United States and now in the Netherlands indicating the low risk of sexual recidivism, but the very high risk of general criminal recidivism, practitioners need to consider the knowledge and research from the general delinquency literature as we consider further research in our field. Last, with trauma as a frequently recurring factor amongst juveniles who offend, early identification and intervention with males who have experienced physical, emotional or sexual insults may be a promising prevention approach.

Abstract

The aim of this study was to investigate group sex offenses with regard to the role of leaders versus followers and to compare both groups on levels of psychopathology, intelligence, and psychosocial and offense-related characteristics. Eighty-nine adolescent group sex offenders (mean age = 14.9, SD = 1.4) referred by the police to the Dutch child protection agency were examined. Psychopathology, intelligence, and psychosocial and offense-related characteristics were assessed by means of standardized instruments, and criminal careers of the participants were ascertained from official judicial records. Although leaders and followers were similar on many characteristics, some remarkable differences were found. During their sexual acts, followers reported using excessive force more frequently than leaders. Furthermore, leaders reported more emotional problems, whereas followers were characterized by higher levels of problems in the social relational domain. As the findings indicate that juvenile group sex offenders constitute a group with specific mental health needs, diagnostic investigation is important to recognize risk factors and (treatable) problems. The absence of some expected differences between leaders and followers could be due to the method of classification or because group offending constitutes a dynamic process without clearly defined roles for individuals.

Citation

‘t Hart-Kerkhoffs, L., Vermeiren, R.R.J., Jansen L.M.C., and Doreleijers, T.A.H.  (2011).  Juvenile Group Sex Offenders:  A Comparison of Group Leaders and Followers. Journal of Interpersonal Violence 26,3-20.

by Steven Bengis, David S. Prescott, and Joan Tabachnick

Question

What differentiates youth who have sexually abused from those who don’t reoffend or reoffend in non-sexual ways?

The Research
In September 2011, Julie Carpentier and Jean Proulx published a study designed to identify the risk factors for re-offense among adolescents who had sexually abused. They chose a sample of 351 male adolescents between the ages of 11 and 18, who had sexually offended and had been assessed at an outpatient center in Montreal, Canada. The study examined over 100 variables to correlate with any new criminal charges in three areas:  overall recidivism; violent recidivism (including violent sexual recidivism); and, sexual recidivism. With a mean follow-up period of 8 years, the results confirm that adolescents who have sexually abused committed other criminal offenses, but few sexually abused again. More specifically, the study indicated that: 10% were charged with at least one new sexual offense; 30% were charged with a violent offense (including sexual offenses); and 45% were charged with a new offense (of any kind). The study concluded that the youth reoffended relatively quickly (almost half of those who commit another offense do so within two years, 75% do so within four years). Identified risk factors for each of the three areas included:

• Sexual Recidivists:  paternal abandonment (plays a particularly important role in sexual criminality beyond adolescents) and association with significantly younger children
• Violent and Overall Recidivists:  an official criminal record, an unofficial history of delinquency, and a diagnosis of ADD (all of which the authors suggest may be understood as indices of impulsivity or low self-control)
• All Recidivists:  Sexual victimization was the only risk factor associated with an increase in the risk of sexual, violent, and overall recidivism

Implications for Professionals

While using different methodologies, several studies, including the present Carpentier and Proulx contribution, have yielded the same conclusion. Only a very small number of youth who offend sexually (in this study, 10%) go on to offend sexually again. But a far higher number commit other general criminal offenses. With an increasing understanding of the factors leading to sexual recidivism, professionals need to: 1) focus on intervention approaches, particularly in the years immediately following an offense, that limit contact with younger children; 2) target therapy/treatment approaches that address the ramifications of paternal abandonment (perhaps a proxy for attachment issues); 3) address the impact of sexual victimization and teach self and energy modulation practices (including the use of appropriate medication) for those with comorbid conditions such as ADHD.

Implications for the Field

With the increasing research about recidivism in adolescents who sexually abuse, the field should use every available opportunity to change public opinion and the public narrative from “once an offender always an offender” to “once a sexually abusive adolescent rarely an adult sexual offender”. The findings suggest that early intervention is key in the lives of these children and adolescents. The authors also challenge us all to see the harm of labeling all adolescents who sexually abuse as “sex offenders” when so few continue to abuse sexually. Further, this study suggests the need to explore the positive impact of strong male relational opportunities as a protective factor and the powerful impact that prevention approaches can have on future victimization given the victim-victimizer correlates.

Abstract

The Carpentier and Proulx study investigates the recidivism rates of a sample of 351 male adolescents who sexually offended, and were assessed at an outpatient psychiatric clinic in Montreal. Over an 8-year follow-up period, 45% (n = 158) of the participants were charged with a new criminal offense, 30% (n = 104) were charged with a violent offense, and 10% (n = 36) were charged with a sexual offense. Cox regression results suggest that overall, violent, and sexual recidivism can be predicted by a variety of developmental, social, and criminological factors. Paternal abandonment, childhood sexual victimization, association with significantly younger children, and having victimized a stranger were associated with a higher risk of sexual recidivism. Previous delinquency, attention deficit disorder, and childhood sexual victimization were found to increase the risk for both violent and overall recidivism. Also, the use of violence during a sex crime and victimizing a stranger were associated with violent recidivism, and school delay and association with delinquent peers were predictive of overall recidivism. The results confirm that a significant proportion of adolescents who have sexually offended pursue a criminal activity beyond adolescence, although few specialize in sexual offending.

Citation

• Carpentier, J and Proulx, J. (2001). Correlates of Recidivism Among Adolescents Who have Sexually Offended.  Sexual Abuse: A Journal of Research and Treatment, 23, 434-455.

Steven Bengis, David S. Prescott, and Joan Tabachnick

Question

With the sexual abuse scandals emerging at Penn State, Syracuse, and other institutions, why did it take so long for people to act?

The Research
In 1994, Christy and Voigt were among the first researchers to look at how witnesses respond to child abuse. Based upon the wealth of bystander literature, they developed a model for determining whether a witness would intervene based on four broad categories. From 567 college students and faculty, these researchers found that 48% of respondents had witnessed child abuse in a public setting, yet only 26% intervened. Data analyses identified 40 statistically significant factors related to whether a bystander intervened. Among the significant findings in each of the four broad categories:

• Bystander Characteristics:  The typical intervening witness was someone who:  believed that the way a parent treats a child “is my business” and felt personally responsible to act; was certain about what to do and how to do it; and typically had been victimized as a child or had witnessed abuse.
• Situational Characteristics:  The typical situation where someone intervened had:  less confusion about what was happening and the intervening witness felt some connection to or communicated with the other witnesses if present.
• Victim Characteristics: Victims were more likely to get help if they:  had some connection with the witness and if the bystander felt some connection or similarity to the victim.
• Perpetrator Characteristics:  The data showed bystanders who took action:  typically knew the people who were abusive and were more likely to act if they observed a situation involving more than one perpetrator.

Finally, the research showed that people intervened both directly (e.g., talked with the person who may be abusive) and indirectly (e.g., called authorities about what they saw) and that the characteristics for direct intervention varied across all four categories.

Implications for Professionals

It is vital for practitioners crafting a safety plans to give friends and family members the tools they need to step in, intervene and help guide a youth towards a healthier lifestyle. This includes:

1. Supporting people and organizations in a youth’s social support network to foster an attitude that “it is my business” to talk with the teen or child whenever he/she begins to step away from the safety plan
2. Teaching the skills needed to intervene
3. Providing organizations working with that teen with information needed to develop policies about both appropriate boundaries and effective responses when an adolescent begins to test those boundaries.

Finally, clinicians can help send a clear message that the more connected an adolescent feels to those around him/her, the more likely others will help maintain everyone’s safety.

Implications for the Field

Through a variety of institutional crises in the last decade from the Catholic Church to the Penn State tragedy, unique opportunities are emerging.  People are asking for more information about both those who perpetrate sexual abuse and those who remain silent. Because of these questions, clinicians now have the opportunity to influence a broader range of professionals concerned with community safety.  Working in a community-based environment can offer enhanced broader range of resources to youth in treatment and open the door for clinicians to share their expertise about assessment, treatment, management, and prevention.

Abstract

Bystander responses to public episodes of child abuse were surveyed among 269 self-reported witnesses. Respondents completed an 80-item self-report questionnaire which inquired into a broad range of events, experiences, and behaviors surrounding naturally occurring incidents of perceived child abuse witnessed in public places. Almost one-half of the sample reported having witnessed at least one event of child abuse in public, but only one out of four witnesses acted to intervene. Data analyses identified 40 statistically significant variables across four categories: characteristics of the bystander, situation, victim, and perpetrator. Results were generally consistent with predictions and findings from previous research on bystander intervention, but a number of new and significant variables were identified that characterized intervention events. Direct and indirect forms of intervention were also distinguished. Implications of the findings are discussed, and educating people to intervene on behalf of abused children is proposed.

Citation

• Christy, C. A. and Voigt, H. (1994), Bystander Responses to Public Episodes of Child Abuse. Journal of Applied Social Psychology, 24: 824-847.

Question

When an adolescent is in denial about his/her offense, what are the clinical and ethical considerations about whether and how to treat this teen?

The Research
Jill S. Levenson reviews research derived both from meta-analysis and single studies and concludes that there is no definitive correlation between denial and recidivism among adult sex offenders. However, some of these studies found that when denial is defined as a continuum of distorted cognitions requiring clinical attention (Langton et al., 2008) decreased denial and increased accountability appear to be associated with greater therapeutic engagement and reduced recidivism for some offenders.

Given the lack of research clarity, Levenson lays out an ethical construct for clinical approaches to denial. Within this framework, Levenson recommends developing a process for ethical decision making based on the standards and ethical code of the profession while considering the available empirical research. She recommends the following:

• Clinicians should consider denial to be an expected defense mechanism and utilize engagement strategies to reduce the shame and anxiety that lead to resistance to treatment;
• Denial should be viewed as a continuum of minimization and rationalization, and addressed as part of the cognitive distortions that are commonly found in sexual offenders; and
• Programs should allow a reasonable time period for clients to engage in the therapeutic process, but should not allow denial to persist indefinitely and should not “Graduate” categorical deniers or consider them “Successful Completers.”

Implications for Professionals

According to Levenson, when deciding on how to address denial, practitioners should:

1. Maintain the autonomy of the client (e.g., ensure that clients are not pressured into admitting and have the opportunity to determine their own values and goals)
2. Consider the client’s beneficence (e.g., consider the offender’s well-being regardless of denial or admission of a crime)
3. Ensure nonmaleficence (e.g., treat someone in denial if they agree to treatment so that harm does not come to offenders or possible victims)
4. Focus on justice (e.g., do not deny treatment to offenders simply because they do not conform to our expectations of the “ideal” client – focus on a client’s need to accept responsibility and make amends)

As clinicians, we can encourage approaches that address the possible reasons for denial (e.g., fear of consequences, shame, guilt, threat to self-esteem, and cognitive dissonance) and allow positive peer influence to have an impact. Over time however, if no responsibility is accepted, the client may be better served by the courts or probation (not the practitioner).

Implications for the Field

Because the research shows very little correlation between denial and recidivism, many researchers are advocating for ways to work with clients who are willing to enter into treatment. Although there is no similar research with adolescents, the field needs to coalesce around ethical, supportive and motivational approaches that encourage acceptance of responsibility by adolescents who may deny the crime. Through group, individual and family interventions, initial denial will, in many instances, yield to greater acceptance of responsibility, especially for future actions.

Abstract

This article addresses ethical questions and issues related to the treatment of sex offenders in denial, using the empirical research literature and the ethical codes of American Psychological Association (APA) and National Association of Social Workers (NASW) to guide ethical decision-making process. The empirical literature does not provide an unequivocal link between denial and recidivism, though some studies suggest that decreased denial and increased accountability appear to be associated with greater therapeutic engagement and reduced recidivism for some offenders.  Clinicians should view denial as a continuum. It might be considered a responsivity factor that can interfere with treatment progress. Offering a reasonable time period for therapeutic engagement might provide a better alternative than automatically refusing treatment to categorical deniers.

Citation

• Levenson, J. (2010). “But I Didn’t Do It!”: Ethical Treatment of Sex Offenders in Denial. Sexual Abuse:  A Journal of Research and Treatment.

by Steven Bengis, David S. Prescott, and Joan Tabachnick

Question

How accurate is the use of clinical judgment, total ERASOR score, and the number of risk factors present in predicting risk of sexual recidivism in adolescents?

The Research
191 male adolescents between the ages of 12 and 19 were assessed by graduate-level practicing clinicians using the ERASOR. All of the youth in the study had been convicted of and/or acknowledged criminal sexual behavior and were receiving treatment in one of five agencies in southern Ontario, Canada. Unlike previous recidivism studies that relied on historical record review for their results, this study used prospective methodology and followed its participants for a period ranging from one month to nearly eight years collecting recidivism data from three sources to increase accuracy.

While acknowledging the study’s limitations, the authors indicated the following study outcomes:

• When using either total ERASOR scores and/or the number of risk factors present, the ERASOR predicted sexual recidivism in both long and short term follow-up;
• With a shorter period of 1.4 years, clinical judgment based on the ERASOR results was also predictive; and
• The research indicated that five dynamic risk factors were signficantly related to sexual recidivism including: obsessive sexual interests/preoccupation with sexual thoughts; antisocial interpersonal orientation; lack of intimate peer relationships/social isolation; interpersonal aggression; and problematic parent-child relationships/parental rejection.

Implications for Professionals

In an age of declining resources and profound social consequences to those who sexually abuse, it is more important than ever to focus our most intensive supervision and treatment interventions on those who are at highest risk to reoffend.  Empirically based risk assessment tools (like the ERASOR, the J-SOAP-II, the J-SORRAT-II, and the MIDSA), offer us the opportunity to more accurately assess the adolescents in our care.  However, as we have written previously, it is vital that professionals do not confuse risk assessment with comprehensive assessments that guide assessment and treatment.

Unlike much of the earlier research, this study examined the total score of the ERASOR, the number of risk factors present and clinical judgments of risk, an important comparison. The conclusion is that clinicians do better making short-term judgments. Thus, clinicians need to be very careful to limit predictive statements based on clinical judgment to shorter time frames, and reassess youth routinely.

This study adds to our growing confidence that, used properly (e.g., not as a stand-alone instrument), the ERASOR and other tools can be used to guide risk assessment. Important to note is that the study points out that none of these scales currently examine the impact of protective factors on recidivism. It is critical that clinicians keep abreast of the current research and apply that information to creating more comprehensive risk assessments, treatment plans, goal setting, and safety plans for each individual adolescent.

Implications for the Field
As the field of sexual re-offense risk assessment develops, researchers are beginning to coalesce around a set of dynamic risk factors that appear to have the strongest predictive validity (aggression, substance abuse, antisocial behaviors, social isolation, and lack of parental involvement). But even in this small sample ERASOR study, there are some adolescents in the low to moderate risk category who go on to offend sexually. Teasing out the factors that may lead to that outcome and weighting those factors accordingly may be important. Of even greater importance (and this is noted by the study authors) is the development of strong protective factors. All the study participants were enrolled in “abuse-specific” treatment programs. How do these programs impact on outcomes, with what specific interventions, relationships, and modalities and how do these modalities need to be modified for different adolescents to ensure a better outcome?

The field has evolved significantly from its earliest years when, in the absence of solid research, a clinician’s subjective opinion about risk was the only option. Today, our work with adolescents is guided by an increasing amount of risk research. Even with this research, the authors offer an important caution:
…although there is often an expectation that risk assessments should be able to pinpoint the exact probability of a reoffense, the accuracy of current risk assessment tools for both sexual and non-sexual recidivism–for both adults and adolescents–is such that precise probabilistic estmates that are generalizable across various populations are not yet possible…..it might also be prudent, therefore, for professionals in the field to continue to educate consumers of risk assessments about the scientific limitations of these tools.

We could not agree more.

Abstract

Data from the Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR; Worling & Curwen) were collected for a sample of 191 adolescent males who had offended sexually. Adolescents were aged 12 to 19 years (M = 15.34; SD = 1.53) at the time of their participation in a comprehensive assessment. The ERASOR was completed by 1 of 22 clinicians immediately following each assessment. Forty-five adolescents were independently rated by pairs of clinicians, and significant interrater agreement was found for the ERASOR risk factors, the clinical judgment ratings (low, moderate, or high), and a total score. Recidivism data (criminal charges) were subsequently collected from three sources that spanned a follow-up period between 0.1 and 7.9 years (M = 3.66; SD = 2.08). Overall, 9.4% (18 of 191) of the adolescents were charged with a subsequent sexual offense over this time period. A shorter follow-up interval of up to 2.5 years (M = 1.4; SD = 0.71) was also examined. Recidivism data for the shorter follow-up interval were available for a subgroup of 70 adolescents, with a comparable recidivism rate of 8.6% (6 of 70). Clinical judgment ratings, the total score, and the sum of risk factors rated as present were significantly predictive of sexual reoffending for the short follow-up period. The total score and the sum of risk factors were predictive of sexual reoffending over the entire follow-up interval. These results add to the emerging research supporting the reliability and validity of structured risk assessment tools for adolescent sexual recidivism.

Citation

• Worling, J.R. Bookalam, D., & Litteljohn, A. (2011). Prospective Validity of the Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR). Sexual Abuse: A Journal of Research and Treatment. Advance Online Publication, 1-21. doi: 10.1177/1079063211407080.

by Steven Bengis, David S. Prescott, and Joan Tabachnick

Question

Why do some adolescents continue to sexually abuse while others stop? What characteristics differentiate adolescents who continue to sexually abuse from those who don’t (or those who continue into non-sexual criminal behaviors)?

The Research
In 2011, Carpentier, Leclerc and Proulx examined factors related to the age of onset, variety of criminal activity, and desistance from sexually abusive behavior in 351 adolescent males:

• For age of onset, the study examined children whose first sexually abusive behavior was committed prior to age 12 (considered early starters) and those who engaged in sexually abusive behavior after the age of 12 (late starters).
• For variety of criminal activity they differentiated two groups, “sex-only aggressors” (no other known criminal behavior) and “sex-plus aggressors” (those known to have engaged in other non-sexual criminal behavior).
• To better understand desistance from criminal behavior, the researchers used reviews of criminal charges to create three categories: stable highs (participants charged with other offenses at least one of which was a sexual offense and/or a violent offense), de-escalators (those charged with offenses that were neither sexual nor violent), and “desisters” (those not charged with any new offense).

The study results suggest that the co-occurrence of BOTH aggressive and sexual deviant behaviors in childhood is associated with continuation of sexually abusive behavior.

The study noted that those adolescents who stopped any criminal behaviors (sexual or otherwise) had fewer cognitive, familial, social, and academic deficits in childhood than those who did continue in some criminal activity. In addition, very few non-offending teens continued with substance abuse or socialization with other delinquent peers. The authors suggest that attachment to family and school are essential protective factors against continued delinquency. The study also noted that adolescents who continued to engage in criminal sexual or violent behaviors (“stable high” groupings) could be differentiated from the teens who continued criminal activity but were neither sexual nor violent (“de-escalators”) by differences related to childhood development. The de-escalators had lower rates of ADD, aggressive behavior, sexual and physical victimization, and long-term paternal absence. The authors concluded that sexual victimization and the long-term absence of a paternal figure at a young age increased the risk of become a “stable high” offender.

Implications for Professionals
This research echoes other studies that point to the need for early intervention in the lives of children who have been sexually traumatized AND exhibit early anti-social behaviors. The study leads us to ask: What kinds of treatment interventions might mitigate the effects of early childhood trauma and the lack of an involved, engaged, stable family or social support networks. This study further illustrates the need for differentiated treatment approaches based on the age of onset, the variety of criminal behavior in which the client engages and persistence of sexual or other criminal behavior has persisted over time.

This study further encourages us to craft interventions that focus on trauma, attachment and socialization as critical risk factors, especially for those children younger than 12 who have general anti-social tendencies. Early trauma can affect a child’s capacity for attachment as well as their academic life, both of which might push a child toward delinquent peers. Finally, in addition to the low base-rates of sexual recidivism for adolescents, this study points out that those youth who only engage in sexually abusive behaviors may have be at lower risk and more amenable to intervention than those youth who began engaged in general as well as sexually criminal behaviors, or who had school problems and went on to associate with delinquent peers. Professionals should pay special attention to variables related to attachment and socialization among adolescents who sexually abuse, since these factors appear critical to understanding and helping these adolescents stop.

Implications for the Field
This research reinforces other studies that support clear differentiations of risk and criminal trajectories amongst adolescents who sexually abuse. This study reinforces our need to examine not only recidivism data, but also the literature in related to other criminal activity (non-sexual) and the study of desistance as well as persistence. Carpentier and her colleagues help to remind us that there is a unique opportunity in public policy to focus limited resources on those whom the research suggests will persist in their sexualized behaviors AND to incorporate successful protective and management interventions that have demonstrated efficacy with the general delinquent population.

Abstract

The aim of the study was to identify the factors associated with age of onset of sexual aggression and variety and desistance of criminal activity among adolescent sexual aggressors. The sample consisted of 351 adolescents who were assessed in an outpatient psychiatric clinic between 1992 and 2002. Recidivism data were collected after a mean follow-up period of 8 years. Indices of early antisocial behaviors (aggressive behavior, anti-social traits) were associated with early activation of a pattern of sexual offending as well as a polymorphic criminal career in adolescence. Findings support previous research indicating that most adolescent sexual offenders who persist in criminal career commit a variety of offenses and do not specialize in sexual crimes.

Citation

• Carpentier, J., Leclerc, B., and Proulx, J. (2011). Juvenile sexual offenders: Correlates of onset, variety, and desistance of criminal behavior. Criminal Justice and Behavior, 38, 854-873.

by Steven Bengis, David S. Prescott, and Joan Tabachnick

Question

Does the age at which a child is sexually abused influence later abusive behavior?

The Research
Adam Grabell and Raymond Knight explored the impact of sexual abuse on youth of several age ranges through a retrospective study of 193 sexually abusive adolescents. Adolescents were selected for the study if their offense(s) were “serious” (e.g., involved “an assault that was sexually motivated and involved physical contact with a victim”).  Given that sexual compulsivity, sexual preoccupation, and hypersexuality are predictors of future offending behavior in adults, the researchers sought to explore these risk factors in an adolescent population. Grabell and Knight hypothesized that the impact of abuse on these risk factors might have the strongest impact at the time during which a child is learning to control impulses and construct cognitions. On the basis of other neuroscience-based research, Grabell and Knight hypothesized that adolescents who were sexually abused when they were three to seven years old were at greatest risk to become abusive. This is the age range where most children learn to control impulses, begin to regulate their emotions, and develop the frontal lobe capacity to mediate between impulse and action.

While expressing extreme caution about their results, the study found that the age group of three to seven was the only age range where sexual victimization demonstrated statistically significant correlations with later abusive behavior.  Indeed, they found that victimization at these ages was associated with poor critical thinking skills later. While identifying the limitations of their methodology (the study’s retrospective approach and the absence of neurodevelopmental testing at the  ages of three to seven), the authors confirmed their hypothesis that developmental age may be an important differentiating risk factor in the development of abusive behaviors in adolescents. They make clear that much additional research will be required to draw any strong causal connections, particularly given the mediating impact of protective factors subsequent to the abuse.

Implications for Professionals
However strong our desire to find causal factors to sexually abusing behavior in adolescents, this study raises as many questions as it answers. These findings illustrate the severe adverse impact of sexual abuse, particularly during the ages of three to seven. Given these results, practitioners would be well served to pay careful attention to the capacity for cognitive flexibility in adolescent abusers who were sexually abused, especially within this three to seven year old age range. The potential neurodevelopmental harm caused by sexual abuse at this age points to the importance of developing critical thinking skills.

Implications for the Field
This study offers an expanded understanding of how early sexual victimization and the development of  thinking skills, compulsivity, sexual preoccupation, and hypersexuality all contribute to future offending. Increasingly, research is showing that the latter three related factors are being recognized as causal risk factors and central to understanding and treating sexual aggression. However, these factors are not issues for all adolescents who abuse, and so careful risk assessment of each individual is necessary for the development of an effective intervention and treatment plan. While this study sheds light on a significant developmental harm and possible risk factor, further research is essential to understanding how sexually abusive behaviors develop and how the variety of interventions can be used to prevent further abuse.

Abstract

Findings in the sexual aggression literature on the link between childhood sexual abuse and future sexual coercion have been inconsistent. In adult sexual offenders, studies have found that the relation of sexual abuse to sexual coercion is mediated by sexually related deviant cognitions, but this mediation is not found when replicated on juvenile sexual offenders. In this study it is hypothesized that this link will be found in juvenile sexual offenders when their sexual abuse history is stratified into discrete developmental epochs. It is further hypothesized that the age range of 3 to 7 years, when children rapidly acquire inhibition and cognitive flexibility skills, will be the most potent predictor. A sample of 193 juvenile sexual offenders is used to examine whether sexual abuse specifically in this discrete period, as opposed to other periods, predicts subsequent sexual fantasy. The results confirm that sexual abuse correlates with later adolescent sexual fantasy only during the 3- to 7-year epoch.

Citation

• Grabell, A. and Knight, R. (2009). Examining Childhood Abuse Patterns and Sensitive Periods in Juvenile Sexual Offenders. Sexual Abuse: A Journal of Research and Treatment, 21, 208-222.

by Steven Bengis, David S. Prescott, and Joan Tabachnick

Question

Is it possible or even advisable to predict re-offense in a youthful offender population?

The Research
In 2010, Gordana Rajlic and Heather M. Gretton published research examining the validity of risk assessment in two assessment tools commonly used within the adolescent field:

• JSOAP-II
• ERASOR

Unlike previous studies, the authors applied these risk tools to two sub-types of youth, those who only offend sexually and those with other antisocial but non-sexual offending. They examined the predictive validity of the two measures when applied to these different groups. The authors acknowledge methodological limitations, such as criminal records as the sole indicator of re-offense, retrospective analysis of antisocial tendencies based on records and not clinical assessments, and the low base-rates of sexual recidivism in the sex-offense only cohort. Their findings support the idea that risk assessment is more accurate and helpful if it accounts for the both the nature of the offense and the presence of other antisocial traits.

Implications for Professionals
This research highlights the strengths and weaknesses of the assessment tools currently in use. The current tools have been proven to be useful for making structured professional judgments about adolescents and their treatment/supervision needs. However, when used alone, they do not adequately consider the developmental, contextual, or diagnostic realities of adolescent. For example, there is nothing inherent in the scoring to differentiate traumatized adolescents from those an autism spectrum disorder. The risk to re-offend likely differs for diagnostically different youth even though the behaviors may be the same. For example, the lack of empathy in a youth with a Pervasive Developmental Disorder does not have the same meaning or significance as the same characteristic in a youth who is Conduct Disordered. The instruments are silent on guiding treatment for these often very different populations and thus cannot be adequately used as stand-alone instruments.

Further, the variation in predictive validity of these tools across a variety of studies indicate that they also have significant limitations when used as predictors of re-offense. A high score on these measures does not necessarily indicate high likelihood of sexual re-offense, just as a low score does not indicate a safe adolescent with no need for intervention. The future of adolescents is too important to rely on a cutoff score on a single instrument, particularly when one considers the high stakes involved in future illegal actions.

At this time, we believe professionals should use risk assessment tools to develop better plans for managing risk and guiding treatment and not use them as vehicles for predicting re-offense. After all, the primary concern for the treatment profession is to understand the nature of risk and identify the steps required to mitigate it. Classifying people according to risk is less helpful than collaborating to ameliorate whatever risks exist and ensure a safe and healthy adolescent when he or she lives in a community.

Implications for the Field
The desire to create or use validated, actuarial type instruments for adolescents is understandable.  Courts sometimes insist on their use and often base their sentencing on the results.  Placement agencies often base their use of residential or secure treatment beds on these same results and several research-based instruments continue to be refined in an effort to ever-more accurately predict re-offense. It is one thing to use these instruments to develop plans; it is quite another to use the numbers they produce to determine a teen’s future life. The complexity of an adolescent’s life and development and the opportunities for change is why the authors believe that providing cut-off scores cannot be applied for general use at this time. In addition, when provided with a numbered score, all professionals must take great care not to make assumptions about risk even if the evaluating clinician takes great care in establishing the limitations/meaning of that objective number. Remaining focused on youth’s ability to change is the highest priority.

The search for prediction has not always recognized the fluidity of adolescence. Given how much all adolescents change in just a few years, and the complexity of their development, it may never be possible to classify them according to risk in any meaningful way. Given the dynamism of this population and the positive impact of targeted interventions, our field can be more effective when we include these measures as key components of comprehensive assessments of treatment and supervision needs, and not be used as stand-alone tools that determine a young person’s future.

Citation

• Gordana Rajlic and Heather M. Gretton. (2010). An Examination of Two Sexual Recidivism Risk Measures in Adolescent Offenders:  The Moderating Effect of Offender Type.  Criminal Justice and Behavior.  37: 1066.